POS0510 INFLUENCE OF CMV INFECTION ON DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: A. Kippenhahn, C. Baerwald, C. Pietsch, O. Seifert
Journal: Annals of the Rheumatic Diseases (2022)

Background The causes of the onset and progression of rheumatoid arthritis (RA) are complex and not yet understood. Some studies suspect viruses as triggers of inflammatory processes (1). Increased numbers of immunomodulatory cells have already been detected in patients with RA infected with the cytomegalovirus (CMV) (2) (3). Understanding the role this infection has on RA-specific disease parameters could help clarify predisposing and prognostic factors. Objectives The aim of this study was to determine the relationship between CMV serostatus and disease activity in patients with rheumatoid arthritis. Methods We performed a retrospective study in adult patients diagnosed with RA. The data was collected between 2008 and 2021 in the rheumatological outpatient department of the University Hospital in Leipzig, Germany. The parameters examined included age, gender, CMV-IgG and CMV-IgM, and the following parameters to record the disease activity of RA: disease duration, joint erosions, rheumatoid factor, anti-CCP antibodies, CRP, disease activity score (DAS28), visual analog scale (VAS) for pain detection, Health Assessment Questionnaire (HAQ), medication with DMARDs and prednisolone. Results A total of 89 RA patients were included, 78.7% of them were female. The mean age was 61.44 ± 10.89 years and the mean duration of illness was 9.48 ± 9.13 years. 56.2% of the patients were CMV-IgG positive, 2.2% CMV-IgM positive. With an OR of 5.04 (95% CI 1.63-15.64), the CMV-IgG titer in women was significantly higher than in men (115.16 vs. 50.75 p = 0.007). This has already been shown in other studies (4). One of the reasons discussed is the women’s closer relationship with children at work. It has also been shown that among women those medicated with DMARDs had significantly higher CMV-IgG titers (126.82 vs. 58.84 p = 0.036). This could be explained by an increased predisposition for CMV reactivation due to the intake of medication. Women with joint erosions were also more likely to be CMV-IgG positive (OR = 3.2; 95% CI 1.02-10.03) and had higher CMV-IgG titers (147.44 vs. 97.23 p = 0.024). Furthermore, seropositive RA women were significantly more likely to be CMV-IgG positive (p = 0.05). This association supports the assumption that CMV may play a role in the pathogenesis of RA. Conclusion The data presented shows that there is indeed a relationship between infection with CMV and parameters for disease activity in patients with RA. In summary, the integration of a CMV status determination into everyday clinical practice in patients with high disease activity could be quite useful and should be discussed. References [1]Davis, John M., et al. A profile of immune response to herpesvirus is associated with radiographic joint damage in rheumatoid arthritis. Arthritis Research &amp; Therapy. 14, 2012, 1. [2]Almanzar, Giovanni, et al. Significant IFNγ responses of CD8+ T cells in CMV-seropositive individuals with autoimmune arthritis. Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology. 77, 2016. [3]Hooper, M., et al. Cytomegalovirus seropositivity is associated with the expansion of CD4+CD28- and CD8+CD28- T cells in rheumatoid arthritis. The Journal of rheumatology. 26, 1999, 7. [4]Cannon, Michael J., Schmid, D. Scott und Hyde, Terri B. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Reviews in medical virology. 4, 2010, 20. Disclosure of Interests None declared.